C.E.O.

COMMUNITY

CONNECTIONS

with

Paul Rosebush

Articles Courtesy of

County Voice, Minden Times & Haliburton Echo

Photo Courtesy Martha Perkins    

Haliburton County Echo.     

HHHS Emergency Department

Patient Satisfaction Survey Results

January 2010   

In September I wrote about an Emergency Department Patient Satisfaction Survey that was planned for the Haliburton and Minden ER’s. Measuring patient satisfaction is becoming increasingly common and provides healthcare organizations with excellent feedback on their performance. Without having a measure to compare to it is difficult to identify and overcome potential weak areas of performance or to identify gaps in services.  Many hospitals contract with external firms to acquire patient satisfaction information but in this era of increasingly limited budgets HHHS decided upon an in-house strategy and conducted its own survey. Taking this route saved the corporation approximately 20K which we have been able to allocate to our front-line operations.

Our patient satisfaction survey was conducted over a two week period between September 21^st and October 4^th.   It consisted of 10 questions and all patients who visited our ERs over that time period were provided with a survey to complete on site or take home with them and mail back to us in a postage pre-paid envelope provided by HHHS. The surveys were colour coded to differentiate results between sites. The surveys were anonymous as we wanted to ensure the confidentiality of participants as well as to encourage impartial feedback. Locked drop boxes to deposit the surveys were available near the exits in order to maintain anonymity.  

 Over the two-week period in which the survey was conducted HHHS had 970 ER visits with 523 people visiting the Minden site and 447 people visiting the Haliburton site  The overall survey response rate was 26.3%.

 The 10 questions dealt with five general areas: 

• Wait-times
• Patient registration services
• Nursing services
• Physician services, and
• Overall impression of ER services

The survey results were extraordinarily positive. Wait-times and the registration process received excellent ratings with 90% of Haliburton patients and 95% of Minden patients registered in under 15 minutes. 90% of the Haliburton patients and 99% of the Minden patients reported being very satisfied with the registration process, while 98% of Haliburton patients and 97% Minden patients expressed high satisfaction with the “friendliness” of the registration nurse.

 Nursing services in general also received positive feedback. 100% of Haliburton patients and 98% of Minden patients felt their nurse acted in a friendly manner and treated patients respectfully. 100% of Haliburton patients and 98% of Minden patients felt that the nurse listened to them attentively. 92% of Haliburton patients and another 92% of our Minden patients felt that the nurse fully explained procedures related to their care.

 In terms of physician services 82 % of Haliburton patients and 95% of Minden patients expressed satisfaction with the time it took for them to see a doctor. 96% of Haliburton patients and 95% of Minden patients felt their doctor was friendly and courteous while 93% of Haliburton patients and 97% of Minden patients felt that their physician communicated well with them.

 On the final survey question addressing overall satisfaction with the quality of care received, 89% of Haliburton patients and 95% of Minden patients expressed satisfaction with their healthcare experience.

 While we are very pleased with the survey results and the quality of care that patients receive when they access services at either site, we are nonetheless extremely motivated to find ways to improve. Our wait-times to see a physician, although generally excellent, presented as a concern for some patients. As such, we need to do a better job informing those waiting about the nature of any unanticipated delays. For instance, it is not uncommon for HHHS to send an ER nurse currently on duty out with an ambulance or transport service so that a patient can receive specialized services or diagnostic support in transit.   When this happens it causes a delay in the ER for patients who are waiting to be seen, as it requires time to arrange for staff backfill.

 To make waits easier and more productive, we will be placing video screens in our ER waiting areas in 2010 to keep patients better advised about their wait time and about healthcare matters in general.  Such an information system would have been helpful to educate patients about pandemic precautions and community resources during the H1N1 outbreak.

 As an update on a few other issues I am pleased to report that HHHS just received its final report card from Accreditation Canada and we received full reaccreditation status. This means that we met or exceeded the quality benchmarks in the services that HHHS provides to the community. All staff at HHHS are congratulated for their remarkable efforts over the last year to achieve reaccreditation.

 HHHS is also close to completing its next 3-year strategic plan. The HHHS Board will be in a position to release the organization’s updated list of priorities to the community in February 2010.

November 2009    

Flu is here,

but don't panic,

CEO says

Posted By Chad Ingram

The head of Haliburton Highlands Health Services is asking the community to remain calm and take the proper avenues to deal with suspected cases of swine flu.               

HHHS CEO Paul Rosebush said last week that the numbers of people coming into the emergency rooms at the organization's Minden and Haliburton facilities were up by at least 20 per cent and wanted to remind people that if they suspect they have contracted the flu, the emergency room is not the place to go.

"If they think they have flu symptoms, they don't have to go to the hospital," Rosebush said.

Instead, Rosebush suggested people visit the websites of either the Haliburton, Kawartha, Pine Ridge District Health Unit or the Central East Local Health Integration Network for tips on recognizing and dealing with the flu.

Rosebush said the best course of action for those with the flu is simply to stay in bed and get plenty of rest.

Regular hand-washing as well as proper sneezing etiquette (into the crook of one's arm and not one's hands) are also very effective methods of reducing the chances of contracting or spreading the sickness, Rosebush said.

A special flu assessment clinic has also been set up at the Haliburton family medical centre and those unsatisfied with online advice are asked to visit the clinic rather than the emergency room. Rosebush said about 40 per cent of people coming into the facilities reporting flu-like symptoms are suffering from an "influenza-like illness."

Whether or not this illness is the H1N1 virus, Rosebush said he was unsure since medical staff are not swabbing to test for specific strains of flu.

There has been one confirmed death from the H1N1 in the Haliburton, Kawartha Pine Ridge District Health Unit jurisdiction, the health unit reported on Nov. 3.

Staff at both facilities had been vaccinated against the H1N1 virus as of last week. While receiving the vaccine is not mandatory for health-care workers, Rosebush said it is strongly encouraged for HHHS staff and that many staff members have happily complied.

The vaccination program is priority-based and health-care workers, pregnant women and people with chronic health conditions have been among the first to receive the vaccine. The health unit is now holding vaccination clinics for people identified as being at a high risk of complications from the H1N1 virus. Those at high risk include people with chronic medical conditions, pregnant women, healthy children aged six months to five years, people residing in remote and isolated communities and household contacts or care providers of people with a high risk of contracted the virus. Clinics will be held at the Haliburton Legion on Nov. 9 from noon to 6 p.m.; Nov. 16 at the Minden Hills Community Centre from noon to 6 p.m.; Dec. 1 at the Lloyd Watson Centre in Wilberforce from noon to 6 p.m.; Dec. 5 at the Haliburton Legion from noon to 6 p.m.; and Dec. 7 from noon to 5 p.m. at the Minden Hills Community Centre.

The number of visitors to emergency rooms throughout the province spiked last week after it was reported a 13-year-old Etobicoke boy had died of swine flu.

Last week attendance at the county's schools was down significantly with many students reporting flu-like symptoms. Cough and fever coupled with muscle aches, joint aches, extreme fatigue or vomiting are considered symptoms of the H1N1 virus.

September 2009   

 With summer winding down in Haliburton, HHHS is preparing to take stock of its performance. We want to hear what people think of our core services and based on the feedback we will work to improve how we do things.  We are proud of our reputation in the community, for our responsiveness and for the personal and compassionate attention that we provide to individuals who receive service from us. We regularly get cards and letters of thanks as well as spontaneous donations from people who express deep gratitude and amazement at the prompt high quality care they receive. We appreciate receiving such feedback but in order to improve we need to know more than “do you like us”. We need your opinion on other aspects of our services such as timeliness, effectiveness, appropriateness, and thoroughness. This information will ensure that we have effective processes in place that address the needs and characteristics of our community.

 With these questions in mind and with a commitment to continuous improvement, HHHS will be asking all visitors to our Emergency Departments in Minden and Haliburton during the last two weeks of September for specific survey feedback on their experience. This information along with our annual survey of Long Term Care residents and families will give us a good measuring stick to evaluate our performance. With the information we receive we will be able to build upon our strengths and develop remedial plans where necessary to improve upon weaknesses.  These surveys will provide the community with a clear voice that will be heard across our organization and have an impact on what we do in the future.

Recently the Central East Local Health Integration Network (CE LHIN), which for the sake of simplicity can be considered HHHS’ regional “boss”, informed residents across our region (from Scarborough to the west and Cambellford to the east and Haliburton to the north) that they too are surveying people on Emergency Department utilization. They have undertaken to poll 1000 people from across our vast region on why they go to an ER. Their focus is to understand why some people go to an ER when it might be more appropriate for them to receive service at a clinic. This information will ostensibly be used to plan regional services that will assist the Ministry of Health and Long Term Care to meet the government’s initiative to reduce wait-times. The CE LHIN web-site also has a survey on its home page that asks the same question. We have been informed that CE LHIN representatives may show up at Hospitals across the region to ask people directly why they choose to go to an ER.  The surveys may seem like duplication but they address similar but different aspects of our services. The LHIN wants to know “why” you go to an ER in order to plan services across the region. HHHS wants to know “what” you experienced at our own ERs in order to improve the services we provide to this community.

 We will post the results of our surveys on our web-site hhhs.on.ca and invite you to take a look. In the meantime if you have any questions about the surveys or any of our services please don’t hesitate to contact me at 457-1392.   

Towards a Common Understanding

of Quality Healthcare                                                                August 2009

Healthcare in Canada is a single payer government funded service that in the truest sense of the word is “public” because it exists for all Canadians. As such healthcare services in Canada are owned by all Canadians who can be considered its principle stakeholders. As stakeholders, the public wants to ensure that its tax dollars are being spent wisely on all public services, including healthcare, and they want to ensure that they receive high quality healthcare when needed. In my last article for the Voice I commented on some of the financial challenges that HHHS faced operating in an era of declining subsidies and increasing costs. In this article I want to highlight what HHHS is doing to provide our community with high quality services.

 Quality is an elusive term and means different things to different people. As a result trying to nail down an operational definition of quality can be challenging. Canadians are more familiar using the term to reflect things such as automobile products, and understand that it has something to do with craftsmanship. The theory goes something like this…the better the product the higher its quality. At HHHS we do not have a product to sell but we do have services that are provided to the public that rely on a high level of skill, knowledge, experience and professionalism. If something goes wrong with the service that we provide to a person the results can be catastrophic. However, in the case of a car when something goes wrong you can generally pull over to the side of the road and call roadside assistance. Therefore, it’s important that people receive assurance from institutions like HHHS that they in fact are receiving quality care. Our funder, the government, also wants to ensure that citizens are receiving the high level of safe, effective and efficient care that they are paying for on your behalf.

 In the last year the HHHS Board spent considerable time and energy reflecting on how to define quality and how to imbed the concept of quality into the everyday operations of the organization.  What the Board arrived at is a comprehensive definition of quality that has been rolled out across the organization to set the bar on quality expectations at HHHS for all employees and hence establish the level of care or support that patients and clients receive.

 The HHHS Board definition of Quality is: The best use of human, technical and financial resources in meeting the needs of clients, patients, residents, and staff with an emphasis on caring and compassionate treatment and services through a focused commitment to a healthy and supportive workplace.

 Boiled down to its essence this definition highlights important themes such as kind, compassionate, safe care for all. These are certainly worthy quality goals that HHHS employees can aspire to and the public can identify with.

 Getting back to the theme of craftsmanship the question of how to measure quality in a healthcare setting arises. At HHHS, to do so, we currently benchmark many of our practices against other similar organizations. As such we measure and track numerous indicators related to human resources, including staff and physician qualifications. We also track the occurrence of infections in our facilities, and the utilization rates of our many services against costs. We also track and evaluate all complaints, accidents, and safety processes, as well as patient and client satisfaction feedback, and financial performance among others. We also participate in a process called “Accreditation” which closely examines the fine details of our services and compares our practices against hospitals across the country. As many Haliburton area residents and seasonal visitors already know our results in all of these areas are excellent.

 In my mind what most defines the quality of care that is provided at HHHS is the attention that all of our staff provide to clients. Research has identified that communication factors make a difference in someone’s assessment of the care they receive. Therefore, it’s not simply whether or not someone received appropriate care but that the person felt they were listened to and treated with dignity and respect throughout their experience.  In essence the patient or client becomes the focus of attention and today’s quality strategies in healthcare emphasize this goal as the premier quality benchmark. From the moment I arrived at HHHS as CEO I could tell that this was the strongest feature of our organization. It was very clear to me that HHHS staff go to great lengths to respond to the individual needs of everyone who walks through our doors. In the future, to drive the concept of quality forward, HHHS is determined to align its current and future strategic goals with its organizational assets and coordinated services in support of continuous performance improvement. Therefore, the concept of quality at HHHS will be aligned from top to bottom throughout the organization as a service priority and everyone on the HHHS team will be working equally toward the same goals.       

 HHHS is fully committed to support the fine efforts of all of our staff who deliver quality services, and work diligently with our partners such as the Central East Local Health Integration Network (CE LHIN) as well as the Ministry of Health and Long Term Care (MOHLTC) to improve the level of quality across all of our hospital, long-term care, and community based services. The community expects this and deserves nothing less. 

The Impact of the Economy on Health Care 

July 2009     

 I am very pleased to have the opportunity to connect with the community on health care issues on behalf of Haliburton Highlands Health Services. The County Voice has been generous to partner with HHHS so that the health care issues facing Haliburton County residents can be shared with the entire community. This is my first article for the Voice and in subsequent months I will be bringing a variety of health care related topics forward that will help the community understand the challenges and opportunities that the health care sector faces. This first article addresses the impact of the economy on services provided by HHHS.

The cost of healthcare continues to present challenges across our country and certainly Haliburton is not immune to the economic forces that are shaping the delivery of health services today. As the global economy has sputtered and the Canadian economy has slumped our healthcare system in Haliburton has taken proactive steps to mitigate the impact of a declining provincial subsidy on our operations.

 Earlier this year Haliburton Highlands Health Services faced closing out the fiscal year end with a significant deficit. It was also well known that the province was not likely to equal last years modest funding increase of 2.4% towards healthcare because of the overall state of the economy.  These two circumstances necessitated a thorough internal review of operations so that HHHS could position itself to maintain its core services intact. Consequently, prior to the announcement of a new budget by the provincial government, HHHS took some meaningful steps. To begin the Board of Directors established guidelines that clearly stated the corporation would not be permitted to run up deficits and further that management would be obligated to take corrective action on any projected deficit in a timely manner. Secondly, HHHS management was able to identify a number of areas where it could decrease costs and improve revenue which were implemented with positive results. Thirdly, staffing adjustments were made to position HHHS to cope with the anticipated funding shortfall.

 The prediction of a reduced subsidy was borne out with the province announcing a 2.1% funding increase in healthcare for the 09/10 period. The anticipatory steps taken by the organization to prepare for this situation was helpful but is by no means a permanent solution to our funding requirements because of the forced growth costs the organization is obligated to meet. For example labour agreements for the current and subsequent year range from 2.6 % to 3%. With 85% of the HHHS budget applied toward staffing the impact of labour costs alone is substantial and the pressure on the budget increases proportionally with such costs. Utility costs also continue to rise dramatically outpacing funding, as do major medical equipment contracts, and maintaining two hospitals and long-term care homes up to high community standards.  Of serious longstanding concern to HHHS is the unfunded cost assumed to transport patients to other hospitals for testing or treatment. This unfunded liability costs the organization over $100,000.00 per year.  HHHS also has to prepare for the future and funds will have to be found to pay for the introduction of electronic health care records so that Haliburton residents can receive the same safe and high levels of care being provided elsewhere.

 The good news is that HHHS improved its financial performance considerably over the prior fiscal year because of the steps taken and described above. The year-end audited statements reflected a very minor deficit of under 1% .  As such HHHS posted one of the best financial results in the Central East LHIN. Staff support and commitment to improving the Corporation’s financial position were vital to achieving this result. HHHS is fully committed to working within a balanced budget and maintaining core services. It will take discipline, properly applied advocacy and the will to seize new opportunities to attract funding that will allow HHHS to cope with the current economic climate and to serve our community capably in the future.             

 County Voice,9